Treatment Options for Dukes Level C Colon Cancer

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Dear OncoLink "Ask the Experts,"
My father has just had surgery to remove a malignant tumor from the right side of his colon (they removed "half" of the colon, according to the surgeon). In the removal, the surgeon took out 20 lymph nodes around the colon; 12 contained cancer cells. The oncologist has rated my Dad on a "Dukes" scale as a level "C". The doctors are not optimistic. Dad is 71 and in good health until now. Is there a good course of treatment for Dad?
Thank you,
M.C.

James P. Stevenson, MD, Assistant Professor of Medicine in the Hematology/Oncology Division of the University of Pennsylvania School of Medicine, responds:

Dear M.C.,
Although we cannot comment on your father's specific case. Assuming that the staging information you have presented is correct and complete, the current recommendations are that your father receive a 6-month course of chemotherapy. In general, the drugs which may be given as a first line treatment in a Dukes Level "C" colon cancer are called 5-fluorouracil ("5-FU") and Leucovorin, and may be given intravenously as an outpatient once a week for six consecutive weeks, followed by a two-week break. We know that this chemotherapy regimen significantly increases your father's chances of being cured of his cancer. Also, there are clinical trials that combine other drugs (either irinotecan or oxaliplatin) with this regimen to see if "more is better." Your father may be a good candidate for these clinical trials: his oncologist could tell you if they are available in your area.

Mar 3, 2015 - In patients with synchronous stage IV colorectal cancer who receive up-front modern combination chemotherapy, immediate colon surgery to remove the primary tumor is seldom necessary, according to research presented at the annual meeting of the American Society of Clinical Oncology, held from May 29 to June 2 in Orlando, Fla. These findings accompanied several other studies presented at the conference focusing on treatment of gastrointestinal cancers.